- BroadPath Healthcare Solutions (Tucson, AZ)
- …staff on managed care and Medicaid policies and procedures D. Conducts staff and medical director audits on appeal activities + Assists with appeal file ... and network facilities to ensure consistent clinical evaluation and processing of medical necessity appeals . Accurate documentation and detailed recordkeeping of… more
- CVS Health (Phoenix, AZ)
- …And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of 40+ colleagues in the ... internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- AmeriHealth Caritas (Philadelphia, PA)
- …for decision making or example, internal committee/panel, independent review organization, internal medical director - as process dictates + Provide support ... coordination of member and/or provider appeals , the analysis of claims and appeals , and the review of medical management authorizations.; + Research and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …in the evaluation of appeals + Review appeal cases and ensure the Medical Director makes timely decisions; + Review final determinations and create decision ... MS Office, including Word, Excel, and Outlook + Proficiency in utilizing Electronic Medical Records (EMRs) + Familiarity with the appeals process, preferably… more
- CVS Health (Springfield, IL)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
- CenterWell (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… more
- CVS Health (Des Moines, IA)
- …will perform concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in ... and in the round robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will perform pharmacy reviews. * The … more
- Centene Corporation (Salem, OR)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... fresh perspective on workplace flexibility. **We're Hiring: Full time Medical Director for Trillium Community Health Plan,...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- Molina Healthcare (Tampa, FL)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... are evidence-based. * Work collaboratively with the Behavioral Health, Pharmacy , Member Outreach, Care Management, National Quality Management, Utilization...coverage review, member appeals clinical review, medical claim review, and… more
- Humana (Indianapolis, IN)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy ), and reviews for… more
- Centene Corporation (Jefferson City, MO)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- Beth Israel Lahey Health (Westwood, MA)
- …120,000 square foot facility in Westwood, MA, provides state of the art pharmacy services to our systems patients and employees. We specialize in patient-centered ... provide the highest level of service and become the pharmacy of choice for all our patients and employees....health care providers with required prior authorization and required appeals . Manage all mail/delivery of Rx orders including addressing… more
- Centene Corporation (Jefferson City, MO)
- … medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . + Participate in provider network development and new market ... plan leaders and cross functional stakeholders across the enterprise + Provide medical leadership for all utilization management, pharmacy , case management,… more
- UCLA Health (Los Angeles, CA)
- …UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan. In this ... key leadership role, you'll work closely with the UHMAP Medical Director and play a vital part in developing and guiding clinical policy that's grounded in the… more
- Elevance Health (Metairie, LA)
- …medication dispensing services to drive affordability and improve member outcomes. The ** Medical Director Associate- CarelonRx** supports pharmacy prior ... ** Medical Director Associate - CarelonRx** **Location:**...is met and we are in compliance with all Pharmacy Benefit Management regulatory requirements. **How you will make… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . Participates in provider network development and new market ... encourage you to apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the medical management, quality… more
- Molina Healthcare (Fort Worth, TX)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- CVS Health (Springfield, IL)
- …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from...inpatient or outpatient services, acute and post acute services, pharmacy , appeals and state fair hearings. You… more
- CVS Health (Trenton, NJ)
- …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... support other plans when needed. This UM (Utilization Management) Medical Director will be a "Work from...on inpatient or outpatient services, acute and post-acute services, pharmacy , appeals and state fair hearings. You… more
